Boriani G, Biffi M, Magagnoli G, Zannoli R, Branzi A
Institute of Cardiology, University of Bologna, Italy.
J Am Geriatr Soc. 2001 Jan;49(1):80-4. doi: 10.1046/j.1532-5415.2001.49014.x.
Low-energy internal atrial cardioversion is a relatively new technique based on delivery of intracardiac shocks through transvenous catheters placed into the atria or the vessels.
The aim of this study was to assess in older and younger patients with chronic persistent atrial fibrillation (AF) the efficacy and safety of transvenous low-energy internal atrial cardioversion performed without routine administration of sedatives or anesthetics.
A prospective longitudinal study.
A cardiological university hospital.
82 patients, divided into older (> or = 60 years) (n = 49) and younger (n = 33) subjects.
Atrial defibrillation threshold for internal cardioversion, measured as leading edge voltage (V) and delivered energy (J) of effective shocks, percentage of patients maintaining sinus rhythm at short-term (within 3 days) and at long-term follow-up.
Patients with chronic persistent AF, treated with oral anticoagulants for at least 3 to 4 weeks, were admitted to hospital. Following a clinical work-up, patients were subjected to low-energy internal atrial cardioversion with shock delivery according to a step-up protocol.
Internal cardioversion was effective in restoring sinus rhythm in 90% (44/49) of the older patients and in 94% (31/33) of the younger patients. Shocks were effective at a mean energy between 6 and 8 joules (range 0.9-23) and administration of sedatives or anesthetics was required during the procedure in 22% (11/49) of older and in 48% (16/33) of younger patients (P = .026 at chi-square). No major complications occurred during the procedure. Pharmacological prophylaxis of AF recurrences was instituted immediately following the procedure. During inhospital stay and during the follow-up (mean 12 +/- 9 months for older patients and 15 +/- 10 months for younger patients), AF recurred in 39% (17/44) of older patients and in 16% (5/31) of younger subjects (P = .064 at chi-square).
Internal low energy cardioversion is a very effective procedure for restoring sinus rhythm in patients with AF; it can be performed in older patients, and administration of sedatives or anesthetics can be avoided or minimized in a substantial proportion of subjects. Recurrences of AF in the long term tend to be higher in older subjects and intensive prophylaxis with antiarrhythmic drugs is required.
低能量心内心房复律是一项相对较新的技术，通过放置在心房或血管内的经静脉导管进行心内电击。
本研究旨在评估在未常规使用镇静剂或麻醉剂的情况下，对老年和年轻慢性持续性房颤（AF）患者进行经静脉低能量心内心房复律的有效性和安全性。
一项前瞻性纵向研究。
一所大学心脏病医院。
82例患者，分为老年（≥60岁）（n = 49）和年轻（n = 33）两组。
心内复律的心房除颤阈值，以有效电击的前沿电压（V）和释放能量（J）衡量，短期（3天内）和长期随访中维持窦性心律的患者百分比。
慢性持续性房颤患者，口服抗凝剂治疗至少3至4周后入院。经过临床检查后，患者按照递增方案接受低能量心内心房复律并进行电击。
心内复律在90%（44/49）的老年患者和94%（31/33）的年轻患者中有效恢复窦性心律。电击在平均能量6至8焦耳（范围0.9 - 23）时有效，22%（11/49）的老年患者和48%（16/33）的年轻患者在手术过程中需要使用镇静剂或麻醉剂（卡方检验P = 0.026）。手术过程中未发生重大并发症。手术后立即开始进行房颤复发的药物预防。在住院期间和随访期间（老年患者平均12±9个月，年轻患者平均15±10个月），39%（17/44）的老年患者和16%（5/31）的年轻患者房颤复发（卡方检验P = 0.064）。
低能量心内复律是恢复房颤患者窦性心律的一种非常有效的方法；它可在老年患者中进行，并且在相当一部分患者中可以避免或尽量减少使用镇静剂或麻醉剂。长期来看，老年患者房颤复发率往往较高，需要用抗心律失常药物进行强化预防。
